AIM

MSN

Website URL

ICQ

Yahoo

Jabber

Skype

Interests

Location

Untreated celiac disease can be life-threatening.
Celiacs are more likely to be afflicted with problems relating to malabsorption, including osteoporosis, tooth enamel defects, central and peripheral nervous system disease, pancreatic disease, internal hemorrhaging, organ disorders (gall bladder, liver, and spleen), and gynecological disorders (like amenorrhea and spontaneous abortions). Fertility may also be affected. Some researchers are convinced that gluten intolerance, whether or not it results in full-blown celiac disease, can impact mental functioning in some individuals and cause or aggravate autism, Aspergers syndrome, attention deficit disorder (ADD), and schizophrenia. Some of the damage may be healed or partially repaired after time on a gluten-free diet (for example, problems with infertility may be reversed). Celiacs who do not maintain a gluten-free diet also stand a much greater chance of getting certain types of cancer, especially intestinal lymphoma. Untreated celiac disease can cause temporary lactose intolerance. Lactose is a sugar found in dairy products. To be digested it must be broken down by an enzyme called lactase. Lactase is produced on the tips of the villi in the small intestine. Since gluten damages the villi, it is common for untreated celiacs to have problems with milk and milk products. (Yogurt and cheese are less problematic since the cultures in them break down the lactose). A gluten-free diet will usually eliminate lactose intolerance. However, a number of adults (both celiacs and non-celiacs) are lactose intolerant even with a healthy small intestine; in that case a gluten-free diet will not eliminate lactose intolerance. Celiacs often suffer from other food sensitivities. These may respond to a gluten-free diet--or they may not. Soy and MSG are examples of food products that many celiacs have trouble with. However, it should be noted that these other sensitivities, while troublesome, do not damage the villi. As far as we know, only gluten causes this damage.

Celiac.com 03/09/2009 - A team of researchers based in Finland recently demonstrated for the first time that B. lactis probiotic bacteria are capable of shielding epithelial cells from cellular damage caused by gliadin exposure.
The research team was made up of doctors K. Lindfors, T. Blomqvist, K. Juuti-Uusitalo, S. Stenman, J. Venäläinen, M. Mäki and K. Kaukinen. They are associated with the Paediatric Research Centre for the Medical School of the Finland’s University of Tampere, the Department of Peadiatrics, and the Department of Gastroenterology and Alimentary Tract Surgery at Tampere University Hospital, and the Department of Pharmacology and Toxicology of the Finland’s University of Kuopio.
In people with celiac disease, wheat gliadin causes serious intestinal symptoms and damages the small-bowel mucosa. Untreated, this can leave the individual at risk of developing various cancers and numerous associated conditions. Most all of this can be reversed or prevented if detected and treated early enough.
Currently, the only effective treatment for celiac disease is a strict life-long gluten-free diet. However, a 100% gluten-free diet is nearly impossible to maintain, with so many gluten-free products containing trace amounts of gluten. Because of this, people with celiac disease face regular gluten contamination. Also because of this, acceptable alternatives are desirable.
Earlier studies have indicated that probiotic bacteria might be used in sourdough fermentation to induce the hydrolysis of celiac toxic gluten in food manufacturing, and thereby benefit people with celiac disease.
Although several studies have addressed the ability of probiotic bacteria to detoxify gliadin after an extensive incubation period, the team found none that investigated whether various live probiotic bacteria can inhibit gliadin-induced toxic effects directly on epithelial cells.
In this study the team set out to determine whether probiotics Lactobacillus fermentum or Bifidobacterium lactis might block the toxic effects of gliadin in intestinal cell culture conditions.
To assess the degree to which live probiotics were able to block peptic-tryptic digested gliadin-induced degradation of human colon cells Caco-2, the team measured epithelial permeability by transepithelial resistance, actin cytoskeleton arrangements by the extent of membrane ruffling and expression of tight junctional protein ZO-1.
B. lactis inhibited the gliadin-induced increase dose-dependently in epithelial permeability, and, at higher concentrations totally eliminated the gliadin-induced reduction in transepithelial resistance.
That is, B. lactis decreased or eliminated the compromise in cell-wall resistance caused by gliadin. This means that B. lactis overcame the mechanism that gives rise to the decreased cell resistance and the increased permeability that occurs during an adverse reaction to wheat gliadin.
The B. lactis strain also interfered with the creation of membrane ruffles in Caco-2 cells caused by gliadin exposure. Furthermore, it also shielded the tight junctions of Caco-2 cells from the toxic effects of gliadin, as shown by the way in which ZO-1 is expressed.
The researchers concluded that live B. lactis bacteria might achieve partial to full blockage of gliadin toxicity gluten/gliadin-induced damage in the small-intestinal mucosa of people with celiac disease, and that it merits further study concerning its potential as a dietary supplement to guard against any silent damage associated with accidental gluten-contamination in celiac disease.
Clinical and Experimental Immunology, 152: 552–558

Celiac.com 09/23/2013 - Patients with non-celiac gluten sensitivity (NCGS) do not have celiac disease, but see an improvement in symptoms when they adopt gluten-free diets.
A team of researchers recently investigated the specific effects of gluten after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates (fermentable, oligo-, di-, monosaccharides, and polyols [FODMAPs]) in patients with suspected NCGS.
The research team included Jessica R. Biesiekierski, Simone L. Peters, Evan D. Newnham, Ourania Rosella, Jane G. Muir, and Peter R. Gibson.
The team performed a double-blind cross-over trial of 37 subjects (aged 24−61 y, 6 men) with NCGS and irritable bowel syndrome (based on Rome III criteria), but not celiac disease.
They assigned study participants randomly to groups given a 2-week diet of reduced FODMAPs, and were then placed on high-gluten (16 g gluten/d), low-gluten (2 g gluten/d and 14 g whey protein/d), or control (16 g whey protein/d) diets for 1 week, followed by a washout period of at least 2 weeks.
The researchers then evaluated serum and fecal markers of intestinal inflammation/injury and immune activation, and indices of fatigue.
The team then crossed twenty-two participants over to groups receiving gluten (16 g/d), whey (16 g/d), or control (no additional protein) diets for 3 days, using visual analogue scales to evaluate symptoms.
They found that gastrointestinal symptoms consistently and significantly improved for all patients during reduced FODMAP intake, but significantly worsened to a similar degree when their diets included gluten or whey protein.
The team saw gluten-specific effects in just 8% of study subjects. They saw no diet-specific changes in any biomarker. During the 3-day re-challenge, participants’ symptoms increased by similar levels among groups. Gluten-specific gastrointestinal effects were not reproduced. An order effect was observed.
A placebo-controlled, cross-over re-challenge study showed no evidence of specific or dose-dependent effects of gluten in patients with NCGS placed diets low in FODMAPs.
Source:
Gastroenterology, Volume 145, Issue 2, Pages 320-328.e3, August 2013.
More info on the FODMAP diet from Stanford Univerisity.

If you’ve been diagnosed with celiac disease, you probably know all about the painful and often uncomfortable physical and mental symptoms and are fortunate to be rid of them with a gluten-free diet. However, avoiding gluten doesn’t mean that your health and well-being are guaranteed, but fortunately you have taken a major step in preventing serious and potentially fatal complications of long-term, untreated celiac disease. There are a few side effects, you could say, associated with a gluten-free diet, but thankfully there are solutions to manage them as you adjust to your new lifestyle.
First, it’s not uncommon to gain weight when you cut gluten out of your diet. Many celiac patients are thin and sickly-looking before their celiac diagnosis, as the damage caused to small intestine prevents the absorption of food. After being on a gluten-free diet for some time, when the intestines have begun to heal, the nutrients and calories in foods get absorbed better. Even though you may not be consuming any more calories now than in your gluten-eating days, it's likely that you're going to gain some weight. In fact, studies have shown an increased risk for obesity for gluten-free dieters. However, some people actually lose weight, as the changes to your diet may cause a decrease in caloric intake. Watching your caloric intake and regular exercise can help deal with any weight gain you may experience.
Patients who are newly diagnosed with celiac disease often find that they have nutritional deficiencies, and what’s worse, gluten-free products are often low in B vitamins, calcium, vitamin D, iron, zinc, magnesium, and fiber and aren’t fortified in these nutrients. When Swedish researchers studied adult celiac patients who had been gluten-free for ten years, they found that half of them had vitamin deficiencies, including low levels of vitamin B-6 or folate, or both, and high levels of homocysteine, a risk factor for heart attacks, vascular disease, and strokes. Before the study, all the patients had biopsies to prove their intestines were in healthy condition, so these vitamin deficiencies could not be explained by malabsorption. Italian researchers have found similar deficiencies in gluten-free adolescents. I recommend that at your annual check-up, you should ask your doctor whether your vitamin status needs to be measured and whether you should be taking folic acid and vitamin supplements.
Another thing to watch out for is increased cholesterol levels. For the first part of my life, when I was eating gluten-containing foods, doctors were amazed by my low cholesterol levels. The reason for this was that my intestines weren’t absorbing the cholesterol in my food. Now I need to pay attention to my cholesterol levels just like other people. This means checking food nutrition labels for not only gluten but also fat and cholesterol content, selecting low-fat, low- low-cholesterol foods. Watch out for packaged gluten-free products, which often have more fat than the gluten-containing foods they substitute, especially gluten-free cookies, crackers, and cakes. The American Heart Association recommends eating high-fiber foods to help lower cholesterol.
Other side effects of a gluten-free diet include constipation, gassiness, and diarrhea. When you replace the bread and pasta in your diet with only processed white rice, you reduce the fiber in your diet, which may cause constipation. On the other hand, adding foods rich in fiber, such as quinoa, in large amounts and too quickly, can cause gassiness and diarrhea.
I was diagnosed with celiac disease many years ago, and since then I have adopted a healthy, gluten-free lifestyle. This was initially quite a challenge, but now I’m reaping the benefits of this new way of life. As a celiac advocate I stay connected to the celiac community and keep abreast of the latest research. This is the first and fundamental step I recommend to celiac patients as they adjust to and manage their gluten-free diet—stay informed.

Celiac.com 06/25/2012 - If you have received a celiac disease diagnosis while taking heart pressure medication, it turns out you might not actually have celiac disease. An investigation led by Dr. Joseph Murray has shown that certain blood pressure medication can cause symptoms not unlike those commonly attributed to celiac disease, and going off the drug can stop the symptoms.
Between 2008 and 2011, 22 patients on the blood pressure medication olmesartan (sold as Benicar) exhibited clear symptoms of celiac disease: intestinal inflammation and abnormalities, chronic diarrhea and weight loss (median weight loss of 39 pounds). One of the patients lost an astounding 125 pounds, and fourteen of the patients exhibited symptoms so severe as to require hospitalization.
All of the patients were diagnosed with celiac disease based on symptoms and intestinal biopsy results, but gluten-free diet caused no improvement in any of the patients. Furthermore, their blood tests came back with results that did not match up with a celiac disease diagnosis.
After taking the patients off olmesartan, all of their symptoms showed dramatic improvement. Eighteen of the 22 had subsequent intestinal biopsies, which revealed improvement in that area as well. It would seem then, that the medication causes celiac-like symptoms.
Some in the medical community have questioned the causal relationship of olmesartan to the symptoms though. As Dr. Franz Messerli of St. Luke's-Roosevelt Hospital, New York argues, “Only re-exposure [to the drug] can confirm the GI side effects were indeed due to olmesartan.”
The sample size has also been called into question by Dr. Henry Black of NYU-Langone Medical Center, who claims that the side effects are highly uncommon and that he uses the drug all the time with no adverse effects. Some have even proposed that the reaction is the result of a drug allergy rather than symptoms related to the mechanism of the drug itself.
The conclusion one can draw from Dr. Murray's findings and subsequent criticisms, is that it is highly likely that olmesartan can cause celiac-like symptoms, but it is not entirely clear how often or why. Those who take it and experience such symptoms (or have gotten a celiac diagnosis while on the drug) should discuss switching to another medication with their doctors. It is still unclear if these symptoms are specific to olmesartan, or can be caused by the entire ARB family of drugs.
As Dr. Murray says, "it's really an awareness issue. We want doctors to be aware of this issue, so if they see a patient who is having this type of syndrome — they think about medications as a possible association."
Sources:
http://abcnews.go.com/Health/blood-pressure-drug-olmesartan-linked-gi-side-effects/story?id=16620314#.T-SpQLUXLR9
http://www.mayoclinic.org/news2012-rst/6956.html?rss-feedid=1

Celiac.com 08/22/2011 - Research has shown that infants with celiac disease have microscopic changes to the intestinal tract, as compared to adults with the disease.
A research team recently examined bacterial differences in the upper small intestine in healthy adults with untreated celiac disease, healthy adults with celiac disease treated with a gluten-free diet, and children with untreated celiac disease, and children with celiac disease treated with a gluten-free diet.
The research team included E. Nistal, A. Caminero, A. R. Herrán, L. Arias, S. Vivas, J. M. de Morales, S. Calleja, L. E. de Miera, P. Arroyo, J. Casqueiro. They are affiliated with the Área de Microbiología, Facultad de Biología y Ciencias Ambientales, Universidad de León, León, Spain.
The team used 16S rRNA gene sequencing of DNA extracted from duodenal biopsies to identify the status of their subjects. The gene sequences from adults and children showed that this intestinal region is colonized by bacteria of three different phyla: Firmicutes, Proteobacteria, and Bacteroidetes.
In total, the team identified 89 different bacterial genera in adults and 46 in children. Children showed significantly lower bacterial richness than did adults. Analysis of the bacterial communities of both healthy and untreated celiac disease patient groups (including both children and adults) showed age to have a strong effect on principal component 1 (clustering all adults and children separately), as well as a possible separate clustering in adults with untreated celiac disease.
The study revealed bacterial differences in the upper small intestine between untreated children with celiac disease and untreated celiac adults due to age. There are differences in the upper small bacteria microbiota between treated and untreated celiac disease adults due to treatment with a gluten-free diet.
Source:
Inflamm Bowel Dis 2011; Aug 8. doi: 10.1002/ibd.21830.

Celiac.com 06/06/2011 - The interplay among the different immune cells mediating intestinal inflammation in celiac disease is complicated indeed. A subset of T regulatory (Treg) cells that express the Foxp3 protein are present in higher numbers in the intestines of patients with active celiac disease than in healthy controls. Treg cells act to suppress the immune system, providing tolerance to self-antigens. A recent report in the American Journal of Gastroenterology demonstrates that these cells proliferate upon the ingestion of gluten in order to suppress an overactive inflammatory response, but that their suppression is in turn suppressed by interleukin-15.
First they confirmed that there is in fact increased expression of Foxp3+ cells in the intestinal mucosa of untreated celiac patients; happily, they write that "no significant differences were noted in the number of Foxp3+ cells in biopsy samples of treated celiac disease in comparison with biopsy samples of non-celiac disease controls." Next, they used an in vitro gliadin challenge system - no celiac patients were harmed during the course of this study! - to see if the increase in this cell population was dependent on gliadin, and it was. T cells are so named because they are made in the thymus; this demonstration that they can originate in the small intestine lamina propria is interesting. Treg cells are generally immunosuppressive, and the Treg cells isolated from celiac guts demonstrated this immunosuppressive ability in vitro. So the researchers wondered: why is there still so much inflammation in untreated celiac disease patients? They found that the cytokine IL-15 could suppress the proliferation of Treg cells, and completely shut down their ability to produce interferon gamma (IFN- Î³ ). This is at least partially because Treg cells from celiac patients turn out to have a significantly higher surface density of receptors for IL-15 than Treg cells from healthy controls, rendering them more sensitive to IL-15's effects.
Zanzi et al bolstered their findings by achieving the same results using two independent experimental methods. It is not yet clear how IL-15 impairs the suppressive activity of Treg cells. But these scientists are actively working on it.
Source:
Am J Gastroenterol advance online publication, 5 April 2011; doi: 10.1038/ajg.2011.80

Celiac disease is known to be triggered, at least in part, by environmental factors. These factors can even affect one identical twin and not the other and seem to have their greatest impact during infancy when gluten is first introduced to the diet. Gut flora makeup and vitamin D levels are 2 factors which differ in infants and could affect the development of the immune system in ways leading to celiac disease. Recent research has shown that gut Bifidobacterium levels are lower in both treated and untreated celiac disease patients. Bifidobacterium species have properties which are beneficial to the immune system such as increasing IL-10 secretion and decreasing intestinal permeability. But other microbiota species may also have important effects and benefits to the developing immune system. Scientists are only beginning to scratch the surface both in cataloging the microbiota species found in the gut and understanding how environmental factors, such as antibiotics, affect their makeup and, in turn, how the makeup of gut microbiota affects human health. A new article on Medscape.com discusses the current state of this research and is excellent reading:
Gut Reaction: Environmental Effects on the Human Microbiota Melissa Lee Phillips Published on Medscape.com: 07/15/2009 http://www.medscape.com/viewarticle/705512_print
It may be years before research fully understands how gut microbiota and vitamin D deficiency may be involved in triggering celiac disease. Both vitamin D and probiotic supplements (such as Bifidobacterium infantis) are cheap, readily available, and generally safe. There is much current research showing how important vitamin D is for overall health. Your infant's health is a matter of immediate concern and cannot wait 5 or 10 years for research to confirm whether such supplements can help prevent celiac disease. It would seem prudent to make use of these supplements now in both mother and infant during pregnancy, while breast-feeding, and prior to introducing gluten to your baby. Consult with your physician about how much is the right dose.

Celiac.com 06/30/2010 - Presently, the only proven treatment for celiac disease is a lifelong gluten-free diet. As part of a gluten-free diet, people with celiac disease are encouraged to avoid consuming foods containing rye, along with avoiding wheat and barley.
However, there is surprisingly little evidence to document the adverse effects of rye in cases of celiac disease. To address this deficiency, a team of clinicians set out to determine conclusively whether rye should be excluded from the celiac diet.
The team included S. M. Stenman, K. Lindfors, J. I. Venäläinen, A. Hautala, P. T. Männistö, J. A. Garcia-Horsman, A. Kaukovirta-Norja, S. Auriola, T. Mauriala, M. Mäki, and K. Kaukinen
They are affiliated variously with the Department of Pediatrics, and the Pediatric Research Center of the Medical School University of Tampere, the Department of Gastroenterology and Alimentary Tract Surgery at Tampere University Hospital, the Department of Pharmacology and Toxicology, the Department of Pharmaceutical Chemistry at the University of Kuopio, the Division of Pharmacology and Toxicology, the Division of Pharmaceutical Chemistry at the University of Helsinki, and Technical Research Centre of Finland.
The goal of the team was to determine whether rye secalin triggers toxic reactions in vitro in intestinal epithelial cell models to the same degree as wheat gliadin.
Moreover, they examined whether the harmful effects of secalin can be reduced by germinating cereal enzymes from oat, wheat and barley to hydrolyze secalin into short fragments as a pretreatment.
The data showed that secalin did trigger toxic reactions in intestinal Caco-2 epithelial cells in a similar manner to gliadin. Secalin triggered epithelial cell layer permeability, tight junctional protein occludin and ZO-1 distortion, and actin reorganization.
High-performance liquid chromatography and mass spectroscopy (HPLC-MS), showed that germinating barley enzymes best degraded the secalin and gliadin peptides. Further in vitro analysis showed that germinating barley enzyme pretreatment ameliorated all toxic secalin-triggered reactions.
From these results, the team concludes that germinating enzymes from barley offer efficient degradation of rye secalin.
In future, these enzymes might be utilized as a novel medical treatment for celiac disease or in food processing in order to develop high-quality celiac-safe food products.
Such enzyme treatments might pave the way for either new treatments for celiac disease, or, new methods of processing rye for production of new, celiac-safe foods.
SOURCE: Clinical & Experimental Immunology DOI:10.1111/j.1365-2249.2010.04119.x

Celiac.com 01/08/2008 - Our recent article on oats brought a number of comments calling our attention to another recent study in which certain types of oats were found to be more beneficial, while others were more likely to be problematical. There still isn’t any official definitive evidence one-way or the other as to just how safe oats are for folks on a gluten-free diet, though there are more studies of this nature being undertaken, and data collection and genetic mapping and testing help us to build a better picture.
A team of Italian and Australian doctors conduced in vitro tests on three different kinds of oats. They wanted to see if certain kinds of oats showed any kind of toxicity in people with celiac disease. These tests showed that the Avenins of the Italian variety Astra and the Australian variety Mortlook showed a much higher activity than those of the Australian Lampton variety, while Rice of the Roma variety showed no activity. Gliadin which is found in wheat and rye showed the expectedly high levels of activity.
Of the oat types tested in this study, the Lampton variety seems to be safer than either the Astra or the Mortlock. However, even oats that are “safer” must still be processed in a dedicated facility that is free of contamination and routinely tested to make sure they meet the minimum levels to be gluten-free. For oat products to be considered gluten-free, they must show less than 20ppm of gliadin.
A study published in the New England Journal of Medicine by Trisha Thompson, M.S., R.D.,* showed that no commercial brand of oats were reliably gluten-free. In fact, nine of the twelve samples from three major brands of oats showed gluten levels ranging from 1,807 to 23 ppm.
There are several companies who now sell "certified gluten-free oats," which are oats that are farmed, harvested, processed and packed using special methods to avoid cross-contamination with gluten during every step of the way. Gluten-free oats currently sell for around $4 to $5 a pound. These type of oats are typically tested for gliadin to less than 3ppm, and are thus considered safe for celiacs who are not sensitive to Avenins.
As far as certain types of oats being better than others, it’s worth some checking, but I’m unsure of the availability of, say, the Lampton strain in America. Also, given the results of commercially available oat brands, the question of the conditions under which the oats were processed becomes very important. Previous studies have shown children with celiac produce significantly greater numbers on antibodies to oat protein than non-celiac children (Scand J Gastroenterol. 2003 Jul; 38(7):742-6).
Many folks with celiac disease are looking to avoid contamination, as no one wants to suffer the unpleasant symptoms of a gluten reaction. Basically, people just want to know what’s safe and to be able to enjoy those items without worrying about getting sick. Since cross-contamination is such a problem of particular importance to celiacs, and since oats grown and processed commercially are likely not gluten-free, it would seem wise to start with gluten-free oats just to be on the safe side.
But anyone looking for a definitive answer will just have to wait. And remember, as with so much with the gluten-free diet, you are the best judge of your own body.
*Thompson T. Gluten Contamination of Commercial Oat Products in the United States. N Engl J Med 2004; 351:2021-2022
Main article: Journal of Gastroenterology and Hepatology 22 (4), 528–531, 2007. Marco Silano, Mariarita Dessì, Massimo De Vincenzi, Hugh Cornell (2007).

Patients Diagnosed in Childhood Might Evolve toward Latency on a Normal Diet Celiac.com 05/23/2007 - The results of a study recently published in the journal Gut indicate that some people who suffer from celiac disease might not need to remain on a gluten free diet for their entire lives, and that some celiac patients might be able to safely introduce gluten containing foods without suffering a relapse. Previous Studies Showing Positive Response to Wheat Introduction in Patients with Celiac Disease are Promising, But Incomplete Several studies have shown that some patients diagnosed with celiac disease in childhood were able to remain on a gluten-containing diet after gluten challenge without suffering a relapse. However, most of these studies included a small number of patients, or followed the patients for only a short period after gluten was reintroduced into their diets. These previous studies also limited their evaluation largely to assessment of celiac disease serology and histology of duodenal biopsies, and did not attempt to identify what factors might predict the development of tolerance to gluten. Determining Long-term Response to Gluten Consumption in Celiac Disease Patients A research team made up of doctors Tamara Matysiak-Budnik (1), Georgia Malamut (1,2), Natacha Patey-Mariaud de Serre (3), Etienne Grosdidier (2), Sylvie Seguier (3), Nicole Brousse (3), Sophie Caillat-Zucman (4), Nadine Cerf-bensussan (1), Jacques Schmitz (5) and Christophe Cellier (1,2), set out to determine whether children diagnosed with celiac disease must follow a gluten free diet for life. To determine the effects of reintroducing gluten into the diets of celiac patients, the research team set out to monitor the clinical and physical progress of adult celiac patients who had been diagnosed as children, who underwent a gluten challenge, and who were asymptomatic. The study focused on a specific group of patients, all but two of whom were diagnosed as children and followed until adulthood in the Department of Pediatric Gastroenterology in Necker Hospital and thereafter at the Georges Pompidou European Hospital in Paris; after which, they were entered into a local register of adult celiac patients and were recruited for the study based on two criteria: celiac disease diagnosed in childhood; and adherence to a normal diet. The patients in the study were from 18 to 65 years old, and had been diagnosed with celiac disease in childhood. The research team recorded data in the following categories: biological parameters of malabsorption; bone mineral density; clinical celiac status; gluten intake; HLA genotype; serological markers of celiac disease; as well as histological and immuno-histochemical parameters in duodenal biopsies.
Results Show 20% Long-term Latency in Celiac Patients who Eat Normal Diet Of those studied, 61 patients had returned to a normal diet, and were asymptomatic. 48 showed various degrees of villous atrophy (silent celiac disease), and 13 had no detectable atrophy (latent celiac disease) on duodenal biopsies. Compared to those with silent celiac disease, patients with latent celiac disease showed markedly less osteopenia/osteoporosis [1/9 (11%) versus 23/33 (70%), p<0.001)], and lower TcR- + intraepithelial T cell counts (38±20 vs. 55±15, p<0.01). Patients with latent celiac disease had a lower mean age at the time of their first gluten free diet compared to patients with silent celiac disease (14.4±5 vs 40.1±47 months, p<0.05). Compared to the seven control patients on a long-term gluten free diet, the latent patients did not differ significantly, except for a higher frequency of celiac disease-specific serum antibodies. However, a follow-up found that two of the patients with latent celiac disease had suffered a clinical and histological relapse. Results showed that of those patients who remained asymptomatic after the reintroduction of gluten, 20% showed long-term latency. The study concludes that some patients with celiac disease may not need to remain on a life-long gluten free diet, and that some may indeed be able to safely reintroduce gluten into their diets with no adverse effects. However, the latency patients may experience may be transient, and therefore a regular follow-up is necessary. Also, patients with silent celiac disease should remain on a gluten free diet. Participating hospitals: (1) INSERM, U793, Faculté de Médecine René Descartes, IFR94, Paris, France. (2) AP-HP, H&OCIRC;pital Européen Georges Pompidou, Department of Hepato-Gastroenterology, Paris, France. (3) AP-HP, H&OCIRC;pital Necker-Enfants Malades, Department of Pathology, Paris, France. (4) INSERM, Equipe Avenir, Faculté de Médecine René Descartes, Paris, France. (5) AP-HP, H&OCIRC;pital Necker-Enfants Malades, Department of Pediatric Gastroenterology, Paris, France. Gut 2006;13(10). Comments on this Study by Ron Hoggan This is dressed up like a new finding, but it isn't. There are a number of studies that show similar findings. Part of that problem lies in the interpretation of the biopsies, and part of the problem arises out of failing to recognize the variable nature of the disease. It has long been known to wax and wane for reasons beyond our ken. Samuel Gee (1888) and Gibbons (1889) both reported the cyclic nature of their patients symptoms. They cited a study to support the idea of a two year rule saying that relapse would usually occur within two years, yet Kuitunen P, Savilahti E, Verkasalo M., in Late mucosal relapse in a boy with coeliac disease and cows milk allergy. Acta Paediatr Scand. 1986 Mar;75(2):340-2. reported one patient who at 4.3 years on a normal diet showed normal villous architecture. It was not until a follow-up biopsy at more than 8 years of eating a gluten-containing diet that he showed villous atrophy. These findings, along with all the other studies that have shown long delays in some patients before relapsing, argue strongly for Michael N. Marsh's position that we should concentrate on treating any immune system that is sensitized to gluten with a gluten-free diet. His rectal challenge is an excellent tool for identifying such sensitized immune systems. Dr. Fines fecal antibody test probably fits into the same category. The underlying assumption is that the biopsy will identify all cases of intestinal lesion regardless of the possibility of patchy lesions that are well documented in the literature. They deal with increased IEL counts as if they were a feature of latent celiac disease when that is not the case. There are several other points on which this study falters. They admit that the latency can be transient. Unfortunately, they have not exchanged emails with people where they have returned to eating gluten and have developed an abdominal cancer. I exchanged emails with such a young man who blamed himself for having killed himself with his carelessness about his diet. How awful that was for him! Yet these authors seem to think it is quite acceptable for patients to indulge during their latency periods and only consider a diet if there is a relapse of intestinal lesion.

Celiac.com 05/08/2007 - One of the strategies for developing alternative therapies for treating celiac disease centers on the identification of antagonist peptides that might inhibit the abnormal immune response caused by gliadin peptides in celiac disease.
A recent study published in the journal Pediatric Research indicates that a peptide that occurs naturally in durum wheat may protect against the effects of celiac disease by acting as an antagonist against gliadin peptides associated with abnormal immune response.
The study was conducted by a team of Italian researchers made up of Drs. Marco Silano, Rita DiBenedetto, Antonello Trecca, Gioachhino Arrabiato, Fabiana Leonardi, Massimo De Vincenzi.
The research team set out to assess the antagonistic effects of 10mer, a decapeptide (sequence QQPQDAVQPF) from the alcohol–soluble protein portion of durum wheat, and to evaluate its prospects for preventing gliadin peptides from activating celiac peripheral blood lymphocytes.
The team extracted peripheral blood mononuclear cells from children with celiac disease who tested DQ2-positive, and from a healthy control group. These samples were then incubated with the peptic-tryptic digest of bread wheat gliadin (GLP) and peptide 62-75 from [alpha]-gliadin, both alone and separately with 10mer.
PBMC proliferation, release of pro-inflammatory Th1 cytokines interferon-[gamma] and tumor necrosis factor-[alpha], release of immuno-regulatory cytokine IL-10, and analysis of CD25 expression as indexes of lymphocytes activation were performed.
Exposure to wheat gliadin peptide and peptide 62-75 from [alpha] gliadin both showed increased activation of lymphocytes. However, the incubation samples with 10mer showed inhibited lymphocyte action.
The study indicates that naturally occurring peptide 10mer in durum wheat may protect against lymphocyte activity in patients with celiac disease, and that further study and evaluation of these findings is warranted.
Pediatric Research. 61(1):67-71, January 2007.

Gut 2000;46:327-331. March 10, 2000 Celiac.com 03/17/2000 - Finish researchers report that people with celiac disease who eat oats show no adverse autoantibody or intraepithelial lymphocyte level effects. According to Dr. M. I. J. Uusitupa (University of Kuopio), and colleagues: Wheat, rye, and barley have harmful effects on the small intestinal mucosa of patients with coeliac disease, whereas maize and rice are harmless...(H)owever, the place of oats in the coeliac diet has been debated. The researchers studied two groups: 40 adults with newly diagnosed celiac disease and 52 adults whose celiac disease was in remission. The people in both groups were randomized to either a conventional gluten-free diet, or a gluten-free diet that also included oats. Both groups were monitored for autoantibodies and intraepithelial lymphocytes over a 6- or 12-month period. In the patients with newly diagnosed celiac disease the disappearance rates of antireticulin antibodies, antigliadin antibodies, and intraepithelial lymphocytes were the same, regardless of their diet. Likewise the people with celiac disease that was in remission had similar antibody and intraepithelial lymphocyte levels between both dietary groups. According to the researchers: These results strengthen the view that adult patients with coeliac disease can consume moderate amounts of oats without adverse immunological effects. The researchers also note that: more clinical studies are needed to ensure the safety of oats when consumed permanently in a coeliac diet as well as to determine the effect of larger amounts of oats.